A Temporary Arteriovenous Shunt (Scribner) in the Management of Traumatic Venous Injuries of the Lower Extremity

Richardson, John B.; Jurkovich, Gregory J.; Walker, Gaylord T.; Nenstiel, Rich; Bone, E. G.

doi:10.1097/00005373-198606000-00003

Cited by 12 publications

(9 citation statements)

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“…Several techniques can be used to increase prosthetic graft patency, such as vein cuffs, vein patches, and AV fistulae [8]. Richardson et al [9] reported the results of temporary AV fistulae for the management of traumatic venous injuries of the lower extremity in 8 patients, and noninvasive Doppler studies performed in 4 of the 8 patients at 3 to 8 months post-repair revealed no evidence of deep venous obstruction [9]. …”

Section: Discussionmentioning

confidence: 99%

Prosthetic Grafting and Arteriovenous Fistula for the Surgical Management of a Common Femoral Vein Injury Using a Staged Approach

Son

Lee

Kang

et al. 2017

Korean J Thorac Cardiovasc Surg

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A 27-year-old female patient was referred due to an edematous left lower extremity. Both saphenous veins had been ablated with an endovenous laser procedure used to treat varicose veins. Venography revealed that the left common femoral vein had been divided and that thrombosis was present at the site of division. No veins were available around the thighs. The patient was treated using a staged procedure. During the first stage, a ringed polytetrafluoroethylene graft was used to repair the common femoral vein, and an arteriovenous fistula was constructed from the femoral artery to the graft using a short segment of cephalic vein to increase graft patency. The edema was relieved postoperatively and the graft was patent. During the second stage, which was performed 6 months later, the fistula was occluded by coil embolization. The staged procedure described herein provides an alternative for venous reconstruction when autologous vein is unavailable.

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Section: Discussionmentioning

confidence: 99%

Prosthetic Grafting and Arteriovenous Fistula for the Surgical Management of a Common Femoral Vein Injury Using a Staged Approach

Son

Lee

Kang

et al. 2017

Korean J Thorac Cardiovasc Surg

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“…Using a dog model, Levin et al [9] demonstrated improvement in patency rates for lower extremity venous reconstructions using either a side-to-side or H-type AV fistula distal to the repair. A series of 8 lower extremity trauma patients has also been reported where a distal, Scribner-type [10] AV shunt was used in vascular reconstruction with good results [6]. Distal AV fistulas are also being studied in the context of decreasing arterial thrombosis in high-risk arterial reconstructions for atherosclerotic disease [11].…”

Section: Discussionmentioning

confidence: 99%

“…However, concurrent arterial/venous reconstruction using reversed contralateral saphenous vein is common practice and well established [3][4][5]. When venous reconstruction is performed, thrombosis at the anastomosis site is a major risk [6]. A 19-year-old patient was referred to the Dana-Farber Cancer Institute (Boston, MA, 02115, USA) and Children's Hospital Boston (Boston, MA, 02115, USA), with a mass in his distal right thigh.…”

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confidence: 99%

Use of a distal arteriovenous fistula in a complex vascular reconstruction after resection of an osteosarcoma in a high-risk child

Linden

Anderson

et al. 2009

Journal of Pediatric Surgery

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“…A fistula is felt to increase the flow through the venous graft thereby enhancing its patency. 16 However, the fistula may increase the distal venous pressure thereby decreasing venous return and worsening the edema, and the resultant decreased distal arterial flow may worsen arterial insufficiency distally. 17 Because of these considerations, we did not consider this added maneuver but relied instead on the use of a pneumatic compression device on the calf.…”

Section: Use Of Ipsilateral Sfv For Cfv Reconstruction After Traumamentioning

confidence: 99%

Use of Ipsilateral Superficial Femoral Vein for Common Femoral Vein Reconstruction After Trauma: A Useful Approach in Selected Cases

Toursarkissian

Corneille

Hagino

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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Trauma. 2006;61:732-735. T he optimal management of complex proximal lower extremity vein injuries remains controversial. Ligation can be tolerated but is sometimes complicated by venous hypertension and possible limb loss. At the same time, the relatively large size of these proximal veins does not lend itself very well to the use of simple saphenous vein grafts, in cases when simple venorrhaphy is not feasible.We describe a case where the ipsilateral superficial femoral vein (SFV) was used as an interposition graft for repair of a complex gunshot induced common femoral vein (CFV) injury. Initial ligation was not tolerated clinically. This method of common femoral vein repair offers a durable autologous conduit that is less time consuming to perform than a panel or spiral saphenous vein graft. CASE REPORTA 24-year-old man presented emergently with multiple gunshot wounds to the left leg and buttock. On arrival he was in shock with a systolic pressure in the 60s. A total of 4 wounds were discovered: one in the lateral distal thigh, a second in the medial distal thigh, a third in the left buttock, and the fourth in the left groin just distal to the inguinal ligament. A pressure dressing was in place on the thigh wound that when released bled torrentially. An emergent laparotomy was performed for proximal arterial and venous control and to rule out intraperitoneal injury. The groin wound was then explored while maintaining proximal and distal digital pressure. A near total transection of the CFV was identified with extensive venous destruction for approximately 4 cm (Fig. 1). A tension free repair was not possible. Because of coagulopathy and hypothermia, the CFV was ligated proximally and distally. The distal thigh injuries were explored and only a saphenous vein transection was discovered. A limited leg angiogram showed no arterial injuries and good runoff to the foot with no other injury. Four-compartment lower leg and lateral thigh fasciotomies were performed and the patient was taken to the intensive care unit (ICU) for further resuscitation. He received a total of 26 units of red blood cells, 12 units of plasma, and a 6 pack of platelets. Despite correction of the coagulopathy, there was continuous venous ooze from the fasciotomy sites requiring ongoing transfusion. In addition, despite leg elevation, he developed massive lower extremity edema from interruption of both his superficial and deep venous systems putting him at risk for venous gangrene. He returned to the operating room 8 hours after his initial surgery for CFV reconstruction. Once the ends of CFV were debrided, an approximately 8 cm gap was present starting slightly above the inguinal ligament and extending to the common femoral vein bifurcation. A segment of the ipsilateral SFV was harvested, starting at its junction with the profunda femoris vein (PFV) (Fig. 2). This segment was used as an end-to-end interposition graft between the PFV and the external iliac vein (Fig. 3). A Greenfield filter was placed at this time because of the patient's...

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A Temporary Arteriovenous Shunt (Scribner) in the Management of Traumatic Venous Injuries of the Lower Extremity

Cited by 12 publications

References 0 publications

Prosthetic Grafting and Arteriovenous Fistula for the Surgical Management of a Common Femoral Vein Injury Using a Staged Approach

Prosthetic Grafting and Arteriovenous Fistula for the Surgical Management of a Common Femoral Vein Injury Using a Staged Approach

Use of a distal arteriovenous fistula in a complex vascular reconstruction after resection of an osteosarcoma in a high-risk child

Use of Ipsilateral Superficial Femoral Vein for Common Femoral Vein Reconstruction After Trauma: A Useful Approach in Selected Cases

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